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Objective: To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped‐care model of intervention delivery. Methods: Using a Type‐I hybrid effectiveness‐implementation design, individuals with stage 0‐II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1‐week post‐intervention on patient‐reported outcomes, including FCR severity (primary outcome), symptoms of depression, anxiety, and stress, melanoma‐related knowledge, and health‐related quality of life. Results: One hundred and twelve participants completed the intervention from 146 participants screened for FCR. Adjusted multivariable linear mixed modelling demonstrated that participants who received the intervention reported a reduced FCR severity at 1‐week post‐intervention (mean change: −3.81 [95% CI: −4.67, −2.95], p < 0.001) compared to baseline. Participants also reported improvements in melanoma‐related knowledge (mean change: 0.64 [95% CI: 0.13, 1.15], p = 0.014), depressive symptoms (mean change: −1.41 [95% CI: −1.92, −0.90], p < 0.001), anxiety (mean change: −1.05 [95% CI: −1.48, −0.61], p < 0.001), stress (mean change: −1.58 [95% CI: −2.22, −0.93], p < 0.001), and health‐related quality of life (mean change: 4.05 [95% CI: 2.84, 5.26], p < 0.001). Conclusions: The Melanoma Care Programme maintained effectiveness when implemented into routine clinical practice with the addition of FCR screening and a stepped care model of delivery. Trial Registration: This study is registered with the Australia and New Zealand Clinical Trials Register (ACTRN12621000145808) [ABSTRACT FROM AUTHOR]

Population‐wide skin cancer screening is not currently recommended in most countries. Instead, most clinical guidelines incorporate risk‐based recommendations for skin checks, despite limited evidence around implementation and adherence to recommendations in practice. We aimed to determine adherence to personal risk‐tailored melanoma skin check schedules and explore reasons influencing adherence. Patients (with/without a previous melanoma) attending tertiary dermatology clinics at the Melanoma Institute Australia, Sydney, Australia, were invited to complete a melanoma risk assessment questionnaire via iPad and provided with personal risk information alongside a risk‐tailored skin check schedule. Data were collected from the risk tool, clinician‐recorded data on schedule deviations, and appointment booking system. Post‐consultation, we conducted semi‐structured interviews with patients and clinic staff. We used a convergent segregated mixed methods approach for analysis. Interviews were audio recorded, transcribed and data were analysed thematically. Participant data were analysed from clinic records (n = 247) and interviews (n = 29 patients, 11 staff). Overall, there was 62% adherence to risk‐tailored skin check schedules. In cases of non‐adherence, skin checks tended to occur more frequently than recommended. Decisions to deviate were similarly influenced by patients (44%) and clinicians (56%). Themes driving non‐adherence among patients included anxiety and wanting autonomy around decision‐making, and among clinicians included concerns around specific lesions and risk estimate accuracy. There was moderate adherence to a clinical service program of personal risk‐tailored skin check recommendations. Further adherence may be gained by incorporating strategies to identify and assist patients with high levels of anxiety and supporting clinicians to communicate risk‐based recommendations with patients. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high‐risk and specific population subgroups. Methods: A cross‐sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023. The primary outcome was Sun Protection Habits (SPH) index (a summary score measured as habitual past month use of sunscreen, hats, sunglasses, a shirt with sleeves that covers the shoulders, limiting midday sun exposure and seeking shade, using a Likert scale). The primary analysis considered the SPH index and its component items scored as continuous. Results: Data from 883 people were analysed. Factors associated with less frequent sun protection behaviours overall included male gender, no personal history of melanoma, lower perceived risk, lower calculated 10‐year risk of developing melanoma, and no private health insurance. People aged >61 years reported lower use of sunscreen but higher use of hats and sleeved‐shirts compared with people in the younger age group. There was no difference in overall sun protection behaviours according to family history of melanoma, country of birth or by lifetime melanoma risk among people without a personal history of melanoma. Conclusions: These findings highlight the potential for targeting high‐risk individuals with less frequent use of sun protection for patient education, public health messaging and ultimately improving sun protection behaviours. [ABSTRACT FROM AUTHOR]

Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited. [ABSTRACT FROM AUTHOR]

Cutaneous VCL::ALK fusion spindle (ovoid) cell tumor is unique. Recently emerged RAS::MAP tyrosine kinase fusion sarcomas more commonly involve subcutis, skeletal muscle and even bone. We share our experience with a novel cutaneous VCL::ALK spindle cell tumor. An 11‐year‐old male presented with a back pedunculated pink–red papule thought to be a pyogenic granuloma. Biopsy histopathology revealed an epithelial collarette with pedunculated tumor extending to deep dermis/subcutis interface. The combination of spindled and epithelioid cells, an ovoid myopericytoid appearance within myxoid to collagenous stroma, low to moderate MIB1 and focal S100 protein without SOX10 immunostaining, were suggestive of a novel RAS::MAPK tyrosine kinase fusion sarcoma that is well described. ALK immunostain being positive, a next‐generation sequencing comprehensive fusion panel was performed to reveal a VCL::ALK fusion. While epithelioid fibrous histiocytoma shares this fusion and similar dermal location and collarette pedunculation, this and other entities were excluded by older patient age, deeper dermal involvement, ovoid‐to‐spindled morphology, central pericytoid vasculature, myxoid stroma, moderate cellularity with low to moderate MIB1 expression, superficial ulceration, and focal S100 protein expression. Complete excision was performed with favorable follow‐up to date. This novel VCL::ALK fusion spindle (ovoid) cell tumor of the dermis is best considered as part of the recently emerged RAS::MAP tyrosine kinase fusion sarcomas. [ABSTRACT FROM AUTHOR]

In the Guyanese Amazon, Waiwai memory is made through the substances and associated sentiments that accrue in the body. Remembering and forgetting are morally weighted actions that transform the dispositions of others, enabling desired feelings of contentment or anger and ill will. Waiwai perspectives on the stakes of being or not being in the thoughts of others matter for their relations with the state: Waiwai people say that, in the past, their households were split between Guyana and Brazil because the Guyanese government forgot about them, while in the present, Waiwai people work to make Guyanese officials remember them, and this constitutes a form of political practice. Whereas anthropological accounts of the politics of memory emphasize how the past is operationalized in the present, Waiwai discussions of being forgotten and being remembered demonstrate the significance of affective, rather than representational, forms of memory for the political practices of indigenous‐state relations. [memory, morality, politics, affect, Waiwai, Guyana, Amazonia] [ABSTRACT FROM AUTHOR]